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Multiple causes for an ischemic stroke: myxoma, papillary fibroelastomas and patent foramen ovale

J Roque1, F Silva, R Arruda Pereira

  • 1Department of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal.

HSR Proceedings in Intensive Care & Cardiovascular Anesthesia
|February 27, 2013
PubMed

Insights

This case highlights a rare combination of cardiac tumors, including myxoma and multiple papillary fibroelastomas, alongside a patent foramen ovale, all contributing to ischemic stroke. Intraoperative echocardiography proved crucial for diagnosis and surgical planning.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Vascular Neurology

Background:

  • Ischemic vascular accidents (strokes) can arise from various underlying pathologies.
  • Rare cardiac tumors, such as myxoma and fibroelastomas, can embolize, leading to stroke.
  • Patent foramen ovale is a known risk factor for cryptogenic stroke.

Observation:

  • A patient presented with acute stroke symptoms.
  • Diagnostic workup revealed a left atrial myxoma and a patent foramen ovale.
  • Intraoperative transesophageal echocardiography identified multiple papillary fibroelastomas on the aortic valve.

Findings:

  • The patient had a rare coexistence of a left atrial myxoma and multiple aortic valve papillary fibroelastomas, along with a patent foramen ovale.
  • This combination of uncommon embolic sources presented a unique diagnostic and management challenge.
  • The incidence of concomitant myxoma and fibroelastoma is exceptionally low, with fewer than five reported cases.

Implications:

  • This case underscores the importance of thorough cardiac evaluation in patients with cryptogenic stroke, especially when multiple potential embolic sources are suspected.
  • Intraoperative transesophageal echocardiography is invaluable for refining diagnoses and guiding surgical strategies in complex cardiac cases.
  • The successful management involved addressing all identified cardiac abnormalities, preventing further embolic events.

Keywords:
embolismintraoperative transesophageal echocardiographymyxomapapillary fibroelastomapatent foramen ovalestroke

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